General hospital psychiatry
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Gen Hosp Psychiatry · Jul 1990
Review Comparative StudyShould neuroleptic malignant syndrome be treated in a private psychiatric hospital or a general hospital?
Neuroleptic malignant syndrome (NMS) has come to be recognized as one of the most serious adverse reactions to neuroleptic therapy. Complications may include cardiopulmonary failure, rhabdomyolysis and renal failure, disseminated intravascular coagulation, infection, dehydration, and shock. This article points out the need for intensive medical management for patients with NMS and questions whether private psychiatric hospitals are adequate to the task.
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Gen Hosp Psychiatry · Mar 1989
Interview assessment of critically Ill patients regarding resuscitation decisions. A case study in ethics research.
To examine how patients perceive and decide their resuscitation status, we monitored 113 admissions to a coronary care unit. We review the research process, including Institutional Review Board concerns, sampling bias and permission by physicians, informed consent, and the patient interview. ⋯ Although standardized psychologic measures indicated distress in some of these critically ill patients, the interview itself induced no detected untoward physiologic or emotional reactions. This pilot study demonstrates the feasibility of assessing patients regarding resuscitation status and also identifies relevant methodologic problems to guide future research of resuscitation decision-making.
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Little has been written about the effects on psychotherapy when a patient who is expected to die survives. A young woman who was nearing the end of routine psychotherapy was found to have breast cancer. ⋯ Psychotherapy, which had begun before the diagnosis, continued during intensive medical treatment and beyond. Some of the changes affecting both the patient and the therapist are described, and some guidelines are suggested for conducting psychotherapy with cancer patients who have prolonged survival.
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The concept of psychogenic pain is discussed and reviewed from multiple theoretical perspectives. The validity of psychogenic pain disorder as a clinical diagnosis is also examined, as are regional pain syndromes such as psychogenic abdominal, facial, pelvic, chest, and headache pain. The term "psychogenic pain" is considered to have limited clinical or diagnostic usefulness and the preferred term "idiopathic pain syndrome" used in DSM-III-R is advocated.
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Gen Hosp Psychiatry · Jan 1987
Case ReportsEthical and management considerations in factitious illness: one and the same.
The literature on factitious illness raises many ethical problems regarding diagnosis and treatment. The author briefly reviews ethical issues in factitious illness and argues for viewing these patients as autonomous citizens, capable of accepting responsibility for their behavior. Some factitiously ill patients psychologically resemble those with borderline personality disorder, and ethical implications are developed. In a case example, the author illustrates how good clinical management assists with the resolution or prevention of these ethical dilemmas.